title: Biologic versus nonbiologic mesh in ventral hernia repair: a systematic review and meta-analysis.
abstract: BACKGROUND
  The current standard of treatment for most ventral hernias is a mesh-based repair. Little is known about the safety and efficacy of biologic versus nonbiologic grafts. A meta-analysis was performed to examine two primary outcomes: recurrence and wound complication rates.
  
  
  METHODS
  Electronic databases and reference lists of relevant articles were systematically searched for all clinical trials and cohort studies published between January 1990 and January 2012. A total of eight retrospective studies, with 1,229 patients, were included in the final analysis.
  
  
  RESULTS
  Biologic grafts had significantly fewer infectious wound complications (p < 0.00001). However, the recurrence rates of biologic and nonbiologic mesh were not different. In subgroup analysis, there was no difference in recurrence rates and wound complications between human-derived and porcine-derived biologic grafts.
  
  
  CONCLUSIONS
  Use of biologic mesh for ventral hernia repair results in less infectious wound complications but similar recurrence rates compared to nonbiologic mesh. This supports the application of biologic mesh for ventral hernia repair in high-risk patients or patients with a previous history of wound infection only when the significant additional cost of these materials can be justified and synthetic mesh is considered inappropriate.
authors.affiliation: Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA, ali_drz@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Darehzereshki
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.forename: Ashkan
authors.initials: A
authors.lastname: Moazzez
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
mesh_terms: D001705:Bioprosthesis; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D013526:Surgical Mesh